MCQ Quiz-PGx review and Bioethics

MCQ Quiz: PGx Review and Bioethics

by

As medicine becomes more personalized through pharmacogenomics (PGx), it raises complex ethical questions. For PharmD students, understanding both the science of how genes influence drug response and the bioethical principles that guide its use is essential. This quiz tests your knowledge on key drug-gene interactions, clinical resources like CPIC, and the ethical frameworks governing genetic testing, research, and patient care in this rapidly evolving field.

1. Which of the following best defines pharmacogenomics (PGx)?

  • The study of how drugs are created from natural products.
  • The study of how an individual’s genetic makeup affects their response to drugs.
  • The science of developing new dosage forms for medications.
  • The economic evaluation of pharmaceutical products.

Answer: The study of how an individual’s genetic makeup affects their response to drugs.

2. The term “phenotype” in the context of PGx refers to:

  • The specific genetic sequence of a patient’s DNA.
  • The observable clinical trait or characteristic resulting from a genotype, such as being a poor metabolizer.
  • A single nucleotide polymorphism (SNP).
  • The wild-type or most common allele in a population.

Answer: The observable clinical trait or characteristic resulting from a genotype, such as being a poor metabolizer.

3. A patient who is a CYP2D6 ultrarapid metabolizer (UM) is prescribed codeine for pain. What is the likely outcome?

  • Decreased conversion to morphine, leading to reduced pain relief.
  • Increased risk of toxicity due to rapid and extensive conversion to morphine.
  • No effect on morphine conversion.
  • Slower clearance of codeine, leading to prolonged effects.

Answer: Increased risk of toxicity due to rapid and extensive conversion to morphine.

4. Clopidogrel is a prodrug that requires activation by which enzyme to become effective?

  • TPMT
  • CYP2C19
  • SLCO1B1
  • DPYD

Answer: CYP2C19

5. A patient who is a CYP2C19 poor metabolizer would likely experience what when taking clopidogrel?

  • Increased antiplatelet effect and higher risk of bleeding.
  • Reduced antiplatelet effect and higher risk of clotting events.
  • A severe allergic reaction.
  • No change in drug effect compared to a normal metabolizer.

Answer: Reduced antiplatelet effect and higher risk of clotting events.

6. The primary purpose of the Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines is to:

  • Regulate the price of genetic tests.
  • Help clinicians understand how to use genetic test results to optimize drug therapy.
  • Mandate which genetic tests must be performed for all patients.
  • Provide marketing information for new drugs.

Answer: Help clinicians understand how to use genetic test results to optimize drug therapy.

7. A patient on warfarin has variants in both CYP2C9 and VKORC1. This information is used to:

  • Predict their risk of an allergic reaction.
  • Determine the best time of day to take the medication.
  • Guide the initial dosing of warfarin to avoid sub- or supratherapeutic INRs.
  • Decide if the patient needs to be on warfarin therapy.

Answer: Guide the initial dosing of warfarin to avoid sub- or supratherapeutic INRs.

8. Variants in the SLCO1B1 gene are associated with an increased risk of myopathy when taking which class of medication?

  • ACE inhibitors
  • Statins
  • Beta-blockers
  • Benzodiazepines

Answer: Statins

9. Thiopurine methyltransferase (TPMT) testing is recommended before initiating therapy with azathioprine to avoid the risk of:

  • Severe, potentially fatal myelosuppression.
  • Liver failure.
  • Kidney damage.
  • A hypertensive crisis.

Answer: Severe, potentially fatal myelosuppression.

10. What are the three core principles of ethical human subjects research outlined in the Belmont Report?

  • Efficacy, Safety, and Adherence.
  • Honesty, Integrity, and Punctuality.
  • Respect for Persons, Beneficence, and Justice.
  • Confidentiality, Anonymity, and Reimbursement.

Answer: Respect for Persons, Beneficence, and Justice.

11. The principle of “Respect for Persons” in the Belmont Report is most directly reflected in which research practice?

  • Using a large enough sample size for statistical power.
  • Ensuring the benefits of the research outweigh the risks.
  • The informed consent process.
  • Fair selection of research subjects.

Answer: The informed consent process.

12. An Institutional Review Board (IRB) is responsible for:

  • Funding the research study.
  • Publishing the results of the research.
  • Reviewing and approving research protocols to ensure the protection and welfare of human subjects.
  • Developing the new drug being tested.

Answer: Reviewing and approving research protocols to ensure the protection and welfare of human subjects.

13. The Nuremberg Code was established as a direct response to:

  • The Tuskegee Syphilis Study.
  • Unethical experiments conducted on concentration camp prisoners during World War II.
  • The development of the first antibiotic.
  • The need for faster drug approval.

Answer: Unethical experiments conducted on concentration camp prisoners during World War II.

14. What is a key ethical requirement of the Declaration of Helsinki?

  • The well-being of the human research subject must take precedence over all other interests.
  • Research is only ethical if it results in a marketable product.
  • All research must be funded by government grants.
  • Researchers can use deception as long as the study has a positive outcome.

Answer: The well-being of the human research subject must take precedence over all other interests.

15. A pharmacist is conducting a research study and obtains a patient’s genetic information. What is the pharmacist’s primary ethical obligation regarding this data?

  • To publish the patient’s name along with the results.
  • To maintain the confidentiality and privacy of the patient’s genetic information.
  • To share the information with the patient’s employer.
  • To sell the data to a marketing company.

Answer: To maintain the confidentiality and privacy of the patient’s genetic information.

16. An “incidental finding” in genetic testing refers to:

  • The result that was expected from the test.
  • A result that is not related to the primary reason for the testing but may be of medical importance.
  • A false positive test result.
  • A test result that is inconclusive.

Answer: A result that is not related to the primary reason for the testing but may be of medical importance.

17. What is a major bioethical dilemma associated with incidental findings?

  • Deciding whether there is a duty to disclose the finding to the patient, especially if it’s unsolicited and for an untreatable condition.
  • How to bill for the additional finding.
  • Whether the finding makes the initial test invalid.
  • How to patent the new genetic discovery.

Answer: Deciding whether there is a duty to disclose the finding to the patient, especially if it’s unsolicited and for an untreatable condition.

18. The Genetic Information Nondiscrimination Act (GINA) protects individuals from discrimination by:

  • All types of insurance companies and all employers.
  • Health insurers and employers, based on their genetic information.
  • Life insurance and disability insurance companies.
  • The military and federal government.

Answer: Health insurers and employers, based on their genetic information.

19. Which of the following scenarios is a potential violation of the ethical principle of Justice in PGx testing?

  • A new life-saving PGx test is made available only to the wealthiest individuals.
  • All patients receive the same PGx test regardless of their condition.
  • A PGx test is covered by a patient’s health insurance.
  • The results of a PGx test are explained clearly to the patient.

Answer: A new life-saving PGx test is made available only to the wealthiest individuals.

20. Informed consent for pharmacogenomic testing should include a discussion of:

  • The purpose of the test.
  • The potential benefits, risks, and limitations of the test.
  • How the results will be used and how privacy will be maintained.
  • All of the above.

Answer: All of the above.

21. A patient with dihydropyrimidine dehydrogenase (DPYD) deficiency is at high risk for severe toxicity from which class of chemotherapy agents?

  • Platinum-based agents (e.g., cisplatin)
  • Taxanes (e.g., paclitaxel)
  • Fluoropyrimidines (e.g., 5-fluorouracil, capecitabine)
  • Anthracyclines (e.g., doxorubicin)

Answer: Fluoropyrimidines (e.g., 5-fluorouracil, capecitabine)

22. A patient asks if their child will inherit their “poor metabolizer” status. The pharmacist should explain that:

  • Genetic traits are not heritable.
  • There is a possibility, and explain basic inheritance patterns or suggest genetic counseling.
  • It is guaranteed that the child will be a poor metabolizer.
  • This information is too complex to discuss.

Answer: There is a possibility, and explain basic inheritance patterns or suggest genetic counseling.

23. The “wild-type” allele refers to:

  • A newly discovered, rare gene variant.
  • An allele that causes a severe adverse drug reaction.
  • The most common or reference allele in a population.
  • An allele that is only found in non-human species.

Answer: The most common or reference allele in a population.

24. Vulnerable populations in research (e.g., children, prisoners, pregnant women) require special protections because:

  • They are less likely to benefit from the research.
  • They may have a compromised ability to provide voluntary informed consent.
  • Their data is more valuable than other populations.
  • They are less expensive to recruit for studies.

Answer: They may have a compromised ability to provide voluntary informed consent.

25. A pharmacist providing a patient with their PGx test results has an ethical responsibility to:

  • Ensure the patient understands the results and their implications for their medication therapy.
  • Simply hand the patient the lab report with no explanation.
  • Tell the patient the results are not important.
  • Advise the patient to disregard their doctor’s advice.

Answer: Ensure the patient understands the results and their implications for their medication therapy.

26. A key difference between basic research and clinical research is that clinical research:

  • Does not require ethical oversight.
  • Involves laboratory animals only.
  • Involves human subjects and is intended to increase knowledge about health and disease.
  • Is always funded by drug companies.

Answer: Involves human subjects and is intended to increase knowledge about health and disease.

27. The principle of Beneficence in research means that:

  • The research must provide a direct benefit to every participant.
  • The research design should maximize potential benefits and minimize potential harms.
  • Researchers should be paid well for their work.
  • The research must be published in a top-tier journal.

Answer: The research design should maximize potential benefits and minimize potential harms.

28. Why is it ethically problematic to use a placebo in a clinical trial when a known, effective therapy already exists for a serious condition?

  • It may violate the principle of Beneficence by withholding a proven treatment from the control group.
  • Placebos are more expensive than active drugs.
  • It makes the statistical analysis more difficult.
  • It is not ethically problematic.

Answer: It may violate the principle of Beneficence by withholding a known, effective treatment from the control group.

29. The term “genotype” refers to:

  • The patient’s observable traits.
  • The set of genes in an organism’s DNA.
  • The physical appearance of a chromosome.
  • The rate at which a drug is metabolized.

Answer: The set of genes in an organism’s DNA.

30. Pharmacists using PGx data must be aware of potential differences in allele frequencies among diverse racial and ethnic populations to:

  • Apply stereotypes in clinical practice.
  • Ensure equitable and accurate interpretation of test results.
  • Justify using different drugs for different races.
  • Fulfill a marketing requirement.

Answer: Ensure equitable and accurate interpretation of test results.

31. In PGx, what does a “prodrug” mean?

  • A drug that is naturally produced by the body.
  • A medication that is inactive and must be metabolized into its active form.
  • A drug that is a mixture of several different compounds.
  • A drug that has no side effects.

Answer: A medication that is inactive and must be metabolized into its active form.

32. The ethical principle of “autonomy” is most closely related to which principle from the Belmont Report?

  • Beneficence
  • Justice
  • Respect for Persons
  • Integrity

Answer: Respect for Persons

33. An ethical issue surrounding direct-to-consumer (DTC) genetic testing is:

  • The tests are always 100% accurate.
  • The potential for misinterpretation of results by consumers without the guidance of a healthcare professional.
  • The results are always shared with employers.
  • The tests are provided for free.

Answer: The potential for misinterpretation of results by consumers without the guidance of a healthcare professional.

34. The primary goal of “OMICS” technologies in personalized medicine is to:

  • Make healthcare more expensive.
  • Stratify disease classification and tailor drug therapy based on a patient’s unique biological profile.
  • Replace the need for pharmacists and doctors.
  • Create a single drug that works for everyone.

Answer: Stratify disease classification and tailor drug therapy based on a patient’s unique biological profile.

35. A patient’s right to “withdraw from a research study at any time” is a key element of:

  • The study’s budget.
  • The informed consent process.
  • The data analysis plan.
  • The publication strategy.

Answer: The informed consent process.

36. A pharmacist who stays up-to-date on the latest CPIC guidelines is demonstrating:

  • Basic legal compliance.
  • A commitment to evidence-based practice and continuing professional development.
  • An interest in billing and coding.
  • A hobby outside of work.

Answer: A commitment to evidence-based practice and continuing professional development.

37. If a PGx test indicates a patient is a poor metabolizer of a drug cleared by CYP2D6, the standard dose of that drug could lead to:

  • Subtherapeutic levels and lack of efficacy.
  • Supratherapeutic levels and increased risk of toxicity.
  • No change in drug levels.
  • A rapid therapeutic response.

Answer: Supratherapeutic levels and increased risk of toxicity.

38. The use of pharmacogenomics in oncology is primarily intended to:

  • Make chemotherapy more toxic.
  • Predict which patients are most likely to respond to a targeted therapy or experience severe side effects.
  • Increase the cost of cancer care.
  • Eliminate the need for radiation therapy.

Answer: Predict which patients are most likely to respond to a targeted therapy or experience severe side effects.

39. Ethical dilemmas in pharmacy often arise when:

  • There is a clear right and wrong answer.
  • Professional obligations, personal values, and legal requirements are in conflict.
  • A patient agrees with everything the pharmacist says.
  • A prescription is easy to fill.

Answer: Professional obligations, personal values, and legal requirements are in conflict.

40. The development of CRISPR gene editing technology has created significant bioethical discussion about:

  • The cost of aspirin.
  • The potential for “designer babies” and edits to the human germline.
  • The proper way to store medications.
  • The dosing of antibiotics.

Answer: The potential for “designer babies” and edits to the human germline.

41. The role of an ethicist or an ethics committee in a hospital is to:

  • Make all treatment decisions for complex patients.
  • Provide guidance and consultation to healthcare providers, patients, and families on difficult ethical issues.
  • Discipline providers who make ethical mistakes.
  • Manage the hospital’s budget.

Answer: Provide guidance and consultation to healthcare providers, patients, and families on difficult ethical issues.

42. A single nucleotide polymorphism (SNP) is:

  • A type of large chromosomal abnormality.
  • A variation in a single DNA building block or nucleotide.
  • A protein that metabolizes drugs.
  • A common brand of genetic test.

Answer: A variation in a single DNA building block or nucleotide.

43. A pharmacist counseling a patient about a new PGx test result must be prepared to address:

  • The patient’s clinical questions about medication changes.
  • The patient’s emotional response to learning about their genetic information.
  • The patient’s concerns about privacy and discrimination.
  • All of the above.

Answer: All of the above.

44. The ethical principle of “non-maleficence” means:

  • To do good.
  • To do no harm.
  • To be fair.
  • To respect autonomy.

Answer: To do no harm.

45. Why is the concept of “justice” important in the rollout of new PGx-guided therapies?

  • To ensure that benefits and risks are distributed fairly and that certain populations are not unfairly burdened or excluded.
  • To ensure the therapy is profitable.
  • To ensure the therapy is approved quickly.
  • To ensure the patent on the therapy is protected.

Answer: To ensure that benefits and risks are distributed fairly and that certain populations are not unfairly burdened or excluded.

46. Which resource is a comprehensive database of pharmacogenomic knowledge, including gene-drug relationships and clinical guidelines?

  • The Food and Drug Administration (FDA) website.
  • The Pharmacogenomics Knowledgebase (PharmGKB).
  • The Centers for Disease Control and Prevention (CDC) website.
  • The National Institutes of Health (NIH) general homepage.

Answer: The Pharmacogenomics Knowledgebase (PharmGKB).

47. When a pharmacist faces an ethical dilemma, a good first step is to:

  • Make a quick decision based on a gut feeling.
  • Ignore the problem.
  • Gather all the relevant facts of the situation.
  • Ask the patient to make the decision.

Answer: Gather all the relevant facts of the situation.

48. The increasing use of PGx in clinical practice requires pharmacists to be competent in:

  • Interpreting genetic test results.
  • Applying clinical guidelines like CPIC.
  • Counseling patients on genetic information.
  • All of the above.

Answer: All of the above.

49. A major ethical concern regarding the use of banked genetic data for future research is:

  • The cost of storing the samples.
  • Ensuring that the initial informed consent was broad enough to cover future, unspecified research.
  • The samples degrading over time.
  • The lack of interesting research questions.

Answer: Ensuring that the initial informed consent was broad enough to cover future, unspecified research.

50. The relationship between pharmacogenomics and bioethics is best described as:

  • Separate fields with no overlap.
  • The science (PGx) creates new capabilities, and the ethics (bioethics) provides the framework for using them responsibly.
  • Bioethics limits the progress of PGx.
  • PGx provides all the answers to ethical questions.

Answer: The science (PGx) creates new capabilities, and the ethics (bioethics) provides the framework for using them responsibly.

Leave a Comment